Hong Kong boasts one of the longest life expectancies in the world and since 2010, it has been ranked No 1 worldwide for the longevity of its residents. According to the latest data from the World Bank, an infant born in Hong Kong in 2020 could expect to live to 85.4 years. Women could expect to live until 88, and men, 83. The average life expectancy for both sexes increased by nearly five years since 1997. Japan came second in 2020 with a life expectancy of 84.6 years (80.4 in 1997), Macau third with 84.4 years (79.6), Singapore fourth with 83.7 years (76.9) and South Korea fifth with 83.4 years (74.6). The United Kingdom ranked 33rd in the world with a life expectancy of 81 years in 2020, up from 77.2 in 1997. The United States had a life expectancy of 77.3 years in 2020, up from 76.4 in 1997. The Post looked at what was going right for Hongkongers’ health and found out why experts also said there were reasons to worry. How did Hong Kong become No 1 for longevity? Experts point to many factors. One major reason was the city’s advanced economy, and the speed with which it developed in the 20th century. By 1996, the year before the handover, Hong Kong had already become one of the world’s most prosperous economies, with a per capita gross domestic product of US$24,818 – behind that of the US, at US$29,967, but just ahead of the UK’s US$24,333. But factors other than wealth matter, because life expectancy can be lower in wealthier places. In 2020, for example, the US had a per capita GDP that was 37 per cent higher than Hong Kong’s, yet Americans’ life expectancy of 77 was eight years shorter than that of Hongkongers. Chinese University Professor Roger Chung, who studies social determinants of health, said the city’s well-developed infrastructure had helped because it provided residents access to essentials such as food, health and social services, among others. Today, Hong Kong has 43 public hospitals and 13 private hospitals. At the end of 2020, there were a total of 34,841 hospital beds in Hong Kong, with the 43 public and then 12 private facilities providing 29,791 and 5,050 respectively. In 1996, 28,626 beds were available, comprising 25,672 provided by 40 public facilities and 2,954 in private institutions, according to the Hospital Authority. Official data showed that in 2021 there were 15,546 doctors, up from 9,289 in 1997, and 64,206 registered nurses, up from 37,880 in 1997. What about infant and maternal mortality? Hong Kong has done well in two other key indicators – the number of babies who die in infancy, and the number of mothers who die before, during or after childbirth. The infant mortality rate has halved since 1997, from four deaths per 1,000 registered live births in 1997 to two per 1,000 in 2020. The world average infant mortality rate in 2020 was 27.4 per 1,000. “Hong Kong’s infant mortality rate is among the lowest in the world, which is a strong indicator of good quality maternal and child healthcare, and of positive social conditions for parents,” said Professor Roger Chung of Chinese University in a 2020 research paper on longevity in the city. In terms of maternal mortality, there were no such deaths in Hong Kong in 2020, an improvement from 1.66 per 100,000 registered live births in 1997. Singapore also had none in 2020, while the US recorded 23.8 deaths per 100,000 live births in 2020, one of the highest maternal mortality rates among developed countries. Are Hongkongers blessed in some way? Chung said he had increasingly come to believe that the exceptional resilience of older Hongkongers was an important factor in explaining longevity in the city. The number of residents aged over 85 rose significantly from 47,300 in 1997 to 235,600 last year. Chung said: “If you think about it, who are the older people now? Most of them were migrants who were healthy and strong enough to come to Hong Kong as refugees back in the 1940s. They survived war, famine, hunger, epidemics, long-distance travelling … back in those wretched days. They are tough and they are survivors.” What are the top killer diseases? Cancer was the No 1 killer for men and women in Hong Kong, according to official 2020 data, followed by pneumonia, heart disease and cerebrovascular disease which included stroke. Cancer accounted for nearly three out of every 10 deaths in 2020. The main causes of cancer deaths were lung, colorectal, liver, pancreas, breast and prostate cancer. Alcohol causes cancer? Calm down bureaucrats. What about being a wine hub? The fifth most common cause of death among men was “external causes of morbidity and mortality” such as intentional self-harm, falls, traffic accidents and accidental drowning. For women, dementia was the fifth most common cause of death. The World Health Organization (WHO) recognised dementia as the seventh leading cause of death globally. Are lifestyles affecting people’s health? Experts have warned that more Hongkongers, and especially younger people, are falling ill because of their diet, sedentary lifestyle, smoking and drinking alcohol. This accounted for a sharp rise in non-communicable diseases (NCDs), such as hypertension, diabetes and high blood cholesterol over recent decades. Professor Martin Wong, a non-communicable disease expert at Chinese University, said: “This has to do with eating and physical habits. People are more inactive, live a sedentary lifestyle with no exercise. During the Covid-19 pandemic, people stayed home most of the time. Also, we are much more prone to the effects of stress.” 1 in 5 men dies before 65. Follow these tips to make sure it’s not you More worryingly, he added, more young Hongkongers were getting these diseases. “Two to three decades ago, most people I treated for NCDs were in their 60s to 70s. Now, a lot of them are in their 30s. This is particularly alarming because NCDs are just the onset of other diseases, and it is likely that 15 years down the road, they will have other medical conditions such as kidney failure. By then, they will still only be around 50, which is not only still young, but the time when they should be at their golden peak.” What was needed, he said, was more health education, primary care and early screening. Are Hongkongers getting fatter? Professor Karen Lam Siu-ling, chair professor in medicine at the University of Hong Kong (HKU), has been tracking obesity in the city. Comparing 1995 and 2019 data, she found the overweight and obesity rates for Hong Kong men did not change much, but women’s rates decreased significantly. “I think this is because, in general, women nowadays are more conscious of their figure and weight,” she said. For her research, Lam used a general criteria for defining overweight and obesity rates among Asian populations, as specified by the WHO in 2004. In the 1995 research by Lam’s team, 19 per cent of Hong Kong males were considered obese, rising by one point to 20 per cent in 2019. In contrast, the women’s obesity rate fell from 25 per cent in 1995 to 13 per cent in 2019. What was more significant to her was how men and women changed in terms of their thickening waistlines, or what she referred to as “central obesity”. “The most striking thing is that central obesity in men of almost all ages has increased over the years,” she said. A person’s waist measurement was a more serious factor than the body mass index (BMI) as central obesity was related to hypertension, diabetes and even cancer, among others, she said. In contrast, Hong Kong women’s waist measurements did not change much over the 25 years, despite it being easier for women to gain central fat, especially in middle age and after menopause. She said although her team’s 2019 survey was still ongoing to match the 3,000 sample size of the 1995 study, the data gathered so far from 1,080 people was adequate for a meaningful comparison. A recent Department of Health study found that children in Hong Kong had become increasingly overweight over the past two years, mainly as a result of lifestyle changes during the Covid-19 pandemic. They were less active and spent more time indoors. What about the state of mental health? The Covid-19 pandemic which arrived in 2020 delivered a blow to residents’ mental health, which was already suffering. An HKU study done just 10 to 12 weeks after the virus started spreading in the city, found that Covid-19 had already caused an “alarming increase in mental health symptoms”. A survey of 3,749 people aged over 18 by the Baptist Oi Kwan Social Service and the Education University of Hong Kong (EdU) earlier this year found that nearly half the respondents had experienced “moderate to severe” anxiety. The number seeking mental health counselling had tripled compared to the same period last year. There is no comprehensive data for 1997. The first citywide study on mental health funded by the government was done between 2010 and 2013 and the findings were published in 2015. It found that one in seven residents had mental health issues such as anxiety, depression or other common mood disorders. It also found that three out of four of those with mental health issues did not seek help. A 2019 survey commissioned by the NGO Mind HK and the Public Opinion Research Institute found that 61 per cent of respondents had signs of poor mental well-being. Who’s at risk of suicide? The city’s suicide rate remained unchanged at 12.1 out of 100,000 deaths between 1997 and 2020, according to the Centre for Suicide Research and Prevention at HKU. The rate peaked at 18.8 out of 100,000 deaths in 2003 when Hong Kong experienced the deadly severe acute respiratory syndrome (Sars) outbreak. There were 1,264 people who took their own lives that year, the majority by jumping from a height. One in four were aged 65 and above. Although the suicide rate declined after that, experts have said that this year might well turn out worse than 2003 because of the Covid-19 pandemic. The city’s suicide index reached a crisis level in the midst of the fifth wave of Covid-19 infections in mid-March, according to researchers at HKU. Those most at risk were the elderly, followed by those aged 35 to 54. How is the government encouraging healthy lifestyles? Over the years, the government introduced many initiatives to improve Hongkongers’ health. Since 2008, a high-level steering committee chaired by the secretary for food and health has focused on tackling the incidence of non-communicable diseases. For a long and healthy life, eat, sleep, feel and exercise the right way The most recent project, “Towards 2025: Strategy and Action Plan to Prevent and Control NCD in Hong Kong”, kicked off in 2018 with nine targets including cutting down salt intake and tobacco usage. Professor Lobo Louie Hung-tak of EdU said the government’s efforts to promote exercise had improved over the past decade. These included the “sports for all” and school programmes by the Leisure and Cultural Services Department, the establishment of a community sports committee in the Home Affairs Bureau in 2005, and the establishment of the Centre for Health Protection since Sars, which allocated more resources to beat NCDs. “There is still a lack of sports grounds, but the Kai Tak Sports Complex that will open in 2023 will be a good addition,” he added. If you are having suicidal thoughts, or you know someone who is, help is available. For Hong Kong, dial +852 2896 0000 for The Samaritans or +852 2382 0000 for Suicide Prevention Services. In the US, call The National Suicide Prevention Lifeline on +1 800 273 8255. For a list of other nations’ helplines, see this page .